Perioperative medicine training resources: U1M4 Considerations for effective communication

Systems that are based on partnering with patients in their own care are used to support the delivery of care. Patients are partners in their own care to the extent that they choose.

Choosing Wisely is an international campaign that promotes a culture where low value and inappropriate clinical interventions are avoided, and patients and health professionals have well- informed conversations about treatment options, leading to better decisions and outcomes.

Abstract
Background
Older people from Culturally and Linguistically Diverse (CALD) backgrounds are increasingly admitted to hospital for acute care reasons, such as surgical procedures. However, there is limited evidence on the perioperative (surgical) experiences and needs of ethnically diverse older adults.

Aim
To synthesise evidence about the perioperative experiences of older adults from ethnically diverse backgrounds.

Methods
An integrative review methodology.

Findings
Eighteen articles were included in the review. Three main themes emerged from the review of the literature; (i) Culturally related factors as drivers to decision-making preoperatively; (ii) Providing culturally responsive and appropriate perioperative information; and (iii) Culturally related considerations for effective self-management postoperatively.

Discussion
The perioperative needs of ethnic groups are contextualised or informed by culture, ethnicity and linguistics. These needs are not necessarily exclusive to those of ethnically diverse backgrounds. For example, the perceived need for understandable information to make an informed decision would be considered as an essential aspect of perioperative care for any patient. However, the need for understandable information and the complexities of effective communication in perioperative settings are compounded by nuances of culture and language.

Conclusion
There needs to be culturally appropriate perioperative processes of care, which build on the standard practice. While patient needs are addressed by universal processes, there is a need to expand and utilise approaches that are culturally and linguistically responsive to older adult patients and their family caregivers. The availability of appropriate mechanisms to engage with healthcare in a culturally meaningful way has the potential to reduce health inequities and improve patient experience.

Abstract
Background: In the context of an effective consumer engagement framework, there is potential for health-care delivery to be safer. Consumers from culturally and linguistically diverse (CALD) backgrounds may experience several barriers when trying to engage about their health care, and they are not acknowledged sufficiently in contemporary strategies to facilitate patient engagement.

Methods: Four focus group discussions were facilitated by bilingual fieldworkers in Arabic, Mandarin, Turkish and Dari in a district of Sydney, Australia that has a high proportion of CALD consumers. Each group included 5-7 health-care consumers who, using a topic guide, discussed their experiences of barriers and facilitators when engaging with health-care services in Australia. Thematic analysis was undertaken to identify, analyse and report patterns in the data.

Results: In all, 24 consumers participated. Six inter-related themes emerged: navigating the health system; seeking meaningful interpretation; understanding and managing expectations; respectful professional care; accessing services; and feeling unsafe.

Conclusions: The incorporation of strategies such as professional interpreters and migrant health workers may go some way to addressing the needs of culturally or linguistically diverse consumers and facilitate communication, but do not sufficiently address the range of barriers to consumer engagement identified in this work. Understanding consumer experience in the context of the complex factors that may be associated with poor engagement and poor outcomes such as health literacy, cultural, educational and linguistic background, and health-care setting or condition, may contribute to better understanding about how to deliver quality health care to these patients.

Abstract
Objective: To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients.

Data sources: A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 and September 2005, and a search of the Cochrane Library.

Study design: Any peer-reviewed article which compared at least two language groups, and contained data about professional medical interpreters and addressed communication (errors and comprehension), utilization, clinical outcomes, or satisfaction were included. Of 3,698 references, 28 were found by multiple reviewers to meet inclusion criteria and, of these, 21 assessed professional interpreters separately from ad hoc interpreters. Data were abstracted from each article by two reviewers. Data were collected on the study design, size, comparison groups, analytic technique, interpreter training, and method of determining the participants' need for an interpreter. Each study was evaluated for the effect of interpreter use on four clinical topics that were most likely to either impact or reflect disparities in health and health care.

Principal findings: In all four areas examined, use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers.

Conclusions: Published studies report positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care.

Abstract
Although health literacy is a concept new to many members of the healthcare community, it has quickly caught the attention of researchers, policy makers, and clinicians due to its widespread impact on health and well-being. Despite the enormous implications of low health literacy, there remains a significant amount of confusion surrounding the concept and its connection with healthcare outcomes. The purpose of this article is to outline the scope of low health literacy as a concept and explore ways that researchers and clinicians can reduce its negative impact on health outcomes. First, the major definitions of health literacy are presented in a brief overview. Then, the concepts of obtaining, processing/understanding, and using information serve as a working framework for discussing both the challenges of low health literacy and strategies to address low health literacy. The authors conclude by identifying areas of research that are needed to advance the conceptualization of health literacy.

Abstract
With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients' understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.

Abstract
Objective: This paper aims to synthesise the broader perspectives of Māori patients and their whānau (extended family, family group) of their treatment within the public health system. Our research question was 'What are the experiences of Māori in the public health and/or hospital system in Aotearoa New Zealand?'

Methods: A systematic search using PRISMA protocols and reflexive typology organised around the categories of Māori, public healthcare and qualitative research identified 14 papers that covered all three categories. We undertook a qualitative metasynthesis on these papers using a critical community psychology approach.

Results: Māori patients and whānau from the included papers mention both barriers and facilitators to health. We categorised barriers as organisational structures, staff interactions and practical considerations. Facilitators were categorised as the provision of whānau support in the form of practical assistance, emotional care and health system navigation.

Conclusions: For many Māori, the existing public health system is experienced as hostile and alienating. Whānau members provide support to mitigate this, but it comes as a cost to whānau. Implications for public health: Public health providers must find ways to ensure that Māori consistently experience positive, high-quality healthcare interactions that support Māori ways of being.